RESEARCH ARTICLE

Nutritional Status, Eating Habits and Foods

Intake by Gestational Diabetes Patients in
National Hospital of Endocrinology
NGUYEN TRONG HUNG 1, LE THI TUYET NHUNG 2, TRAN THI TRA PHUONG 1, HA THI VAN 1,
CHU THI TRANG 3, PHAM THI THU HUONG1, NGUYEN THI LAM 1, NGHIEM NGUYET THU 1,
PHAN HUONG DUONG 4, TRAN NGOC LUONG 4, LE DANH TUYEN1
¹ National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam, Email: nguyentronghung9602@yahoo.com.
² Andrology and Fertility Hospital of Hanoi, 431 Tam Trinh Street, Hanoi, Vietnam
3
Vietnam-Germany Friendship Hospital
4
National Hospital of Endocrinology, 215 Ngoc Hoi Street, Hanoi, Vietnam

ABSTRACT
KEYWORDS:
A cross-sectional study of 60 gestational diabetes mellitus patients who were
Nutritional status, gestational
examined and treated at National Hospital of Endocrinology in 2017 aimed to diabetes mellitus (GDM),
determine the nutritional status, eating habits and foods intake by these subjects. National Institute of Nutrition,
The results were most gestational diabetes mellitus patients had a body mass index National Hospital of Endocrinology

of 18.5 ≤BMI <25 (76.7%); the rate of overweight and obesity was 6.7%, malnutrition
was 16.6%. Total dietary energy was 1841.7±92.2kcal and energy level of ARTICLE HISTORY:
29.5±1.5kcal/kg body weight. Dietary protein was 18.7%, dietary lipid was 29%, Received April 10, 2021
Accepted April 22, 2021
dietary carbohydrate was 52.3% for total energy. the iron in the diet of gestational Published May 20, 2021
diabetes was 14.5±0.9mg/day. The folate intake approximately 400mcg/day, the
calcium intake 700mg/day, the vitamin D in the diet was 20IU/day, vitamin B12
DOI:
about 2.3mcg/day and zinc about 13.5mg/day. The percentage of gestational 10.5455/jcmr.2021.12.02.17
diabetes mellitus patients who ate ≥ 3 meals per day saw the highest rate of 76.7%;
gestational diabetes mellitus patients ate 1 meal with the lowest rate of 3.3%. In
VOLUME: 12
terms of the frequency of food consumption, meat was the highest group of food ISSUE: 2
consumption with 100% and seafood fish types were 10%. Rice - the highest ISSN: 2146-8397
consumed food accounted for 100%, then to the bread, dumplings taking up 10%.
Oil, peanut group consumed accounted for 86.7% whereas the lowest group was
animal’s fat with 3.3%. All kinds of vegetable consumed recorded 96.7%. In
conclusion, the nutritional diet of women with gestational diabetes with the ratio of
3 thermogenic substances Protein: Lipid: Carbohydrate were 18.7:29:52.3, which
was not consistent with the guidelines of the American Diabetes Association 2017
but also quite consistent with the nutritional facts and habits in Vietnam.

INTRODUCTION in pregnancy, ranging from 1-28% [2] and is on the rise,

Diabetes mellitus is a chronic disease characterized by
chronic hyperglycaemia along with disturbances of
metabolism of carbohydrates, proteins, and lipids due to
decreased insulin secretion, decreased ability to function
insulin or both [1]. Gestational diabetes mellitus (GDM) is a
special type of diabetes. This is a common metabolic disorder
especially in the Asia-Pacific region, including Vietnam [3],
[4], [5]. The World Health Organization (WHO) definition,
GDM is a disorder of glucose tolerance at any level, onset or
first detected during pregnancy [6]. Compared with whites,
the risk of gestational diabetes increased by 7.6 times in
Southeast Asians [7]. In Vietnam, the estimated incidence of
the disease is from 5.9 to 39% depending on the method of
 144 Nutritional Status, Eating Habits and Foods Intake by Gestational Diabetes Patients in National Hospital…
screening, screening pregnancy week, diagnostic criteria and
population characteristics [3], [8].
The first of gestational diabetes mellitus diagnostic criteria
recommended by John Oimullivan and Claire Mahan in 1964.
They set up diagnostic criteria based on the incidence of
related diseases. Those who meet this diagnostic criterion are
at increased risk of complications for the newborn and are
particularly at increased risk of diabetes mellitus in the
future with a 28-year follow-up period [9]. In 2010-2011, The
International Association of the Diabetes and Pregnancy Study
Group (IADPSG) and American Diabetes Association (ADA)
agreed to standard of diagnosis of gestational diabetes [10],
[11]. If gestational diabetes is not diagnosed and treated,
there is a high risk of obstetrical and pediatric complications
such as pre-eclampsia, abortion, stillbirth, neonatal
pregnancy, perinatal death, and fetal enlargement, increase
the risk of difficult delivery and cesarean delivery [12], [13],
[14] ... Infants of mothers with gestational diabetes are at
risk of hypoglycemia, hypocalcemia, jaundice, when older
children will be at risk of obesity, diabetes typ 2 [15], [16].
About 30-50% of women with gestational diabetes will get
gestational diabetes at the next pregnancy [17].
Approximately 20-50% of mothers with gestational diabetes
will became diabetes mellitus in 5-10 years after birth [18],
the risk of type 2 diabetes increases 7.4 times [17]. As
recommended by the American Diabetes Association, women
at high risk of gestational diabetes should be screened for
screening for gestational diabetes at the first pregnancy
check-up. [19].
Many studies on gestational diabetes have been conducted, so
the knowledge about the disease and its control is
increasingly effective. The research results in Vietnam and
the world show that the incidence of disease is on the rise
day by day. A study conducted in the Department of
Endocrinology at Bach Mai Hospital (2012) showed that the
rate of pregnant women with gestational diabetes accounted
for 39% [3]. Moreover, the research results also pointed out
some risk factors for gestational diabetes: family history,
history of disease, nutritional status before pregnancy,
Table 1: Diagnosis of GDM with a 75-g oral glucose load
mg/dl
Fasting 92
1h 180
2h 153
Exclusion: Patients with diabetes before pregnancy, patients
with diseases affecting carbohydrate metabolism (Basedow,
hypothyroidism, cushing, adrenal myeloma, liver failure,
kidney failure ...), patients are using drugs affecting
carbohydrate metabolism (corticosteroids, salbutamol,
sympathomimetics blockers, thiazide diuretics ...) or are
suffering from acute diseases.
Sampling size and sampling method
Used a sample size formula describing the characteristics of a
patient with gestational diabetes
weight gain and regimen. Nutrition of pregnant women during
pregnancy [20], [21], [22], [23], [24].
Recently studies have demonstrated the effectiveness of
dietary modifications for the treatment of gestational
diabetes: good blood sugar control and reduction of obstetric
complications [3], [25], [26], [27]. The National Hospital of
Endocrinology is a terminal hospital for the treatment of
endocrine diseases and metabolic disorders and is in charge
of the National Diabetes Prevention Program. Therefore, we
conducted the project: "Nutritional status, eating habits and
food intake of gestational diabetes patients in National
Hospital of Endocrinology". The aims of this study have
evaluated diet of pregnant women with gestational diabetes
as well as describe some characteristics: family history,
history of disease, nutritional status before pregnancy,
weight gain during pregnancy to the situation Diabetes
pregnancy. And at the same time, it also helps to provide
more information in nutrition counseling for pregnant women
with gestational diabetes.
MATERIALS AND METHODS
Study Subjects
A cross-sectional study was designed to collecting 60
pregnant women who came for examination and treatment at
the Department of Reproductive Endocrinology at National
Hospital of Endocrinology in 2018.
This study used the cut-off points for the diagnosis of
gestational diabetes mellitus based on the American Diabetes
Association criteria 2011 [28].
Women have testing undertaken at 24–28 weeks of gestation
who found not to have diabetes mellitus before. The test
should be done in the morning after an overnight fast of
between 8 and 14 h and after at least 3 days of unrestricted
diet (≥ 150 g carbohydrate per day) and unlimited physical
activity. The subject should remain seated and should not
smoke throughout the test. At least one of the venous plasma
concentrations must be met or exceeded for a positive
diagnosis (Table 1).
mmol/l
5.1
10.0
8.5
In which: n: number of patients, t: normalized percentile (t =
2, probability 0.954). ϭ: standard deviation = 187.5 (standard
deviation taken from a previous study [29]). e: permissible
error = 50Kcal (error in the question to write the serving size
is 35-50Kcal). N: 1000 (is the number of patients hospitalized
with gestational diabetes in 1 year). Number of patients: n =
Nguyen Trong Hung et al. 145

54 patients, with 10% prophylaxis, the sample size needed to The height of students was measured in centimeters (cm) by
collect was 60 patients. the Microtoise stature meter with the precision of 0.1 cm,
while weight was measured in kilograms (kg) using a Tanita
The study sample was selected based on the convenient
digital scale. Body mass index (BMI) was then calculated, and
sampling method. All patients who stayed in hospital during
overweight and obesity were classified based on the gender-
the time of conducting the study and met the selection
and age-specific BMI and World Health Organization (WHO
criteria above were selected for the study until there were
2000): BMI= Weight (kg)/Height² (m) (Table 2). [30].
enough sample sizes.

Variable research

Table 2: BMI classification [6]

BMI (kg/m²) Classification

< 18,5 Chronic Energy Disease

18,5 – 24,9 Healthy Weight
25 – 29,9 Overweight (Pre-obesity)
≥ 30 Obesity

- Diet of pregnant women (Protein, Lipid, Carbohydrate) times/week, ≥ 2 times/day, 1 time/day.

- Eating habits of pregnant women (Eat on time, number of
meals a day)
- Frequency of food consumption (group of meat, fish, rice, asking pregnant women directly on interview date.
cooking oil, fat, green vegetables)
Methods of information collection
Interviewed subjects from the date of admission using
questionnaires combined with oral record. Subjects to record
the 24 hours dietary recall were asked. Diets are calculated
nutritional values according to a table developed by the
National Institute of Nutrition based on data on nutritional
ingredients of foods in Vietnam [9]. The frequency of
consuming certain foods in the past month of study subjects
is recorded. The frequency is classified according to the
landmarks: Never, 1-3 times/month, 1-2 times/week, > 2-4
Collect measurements of weight and height of subjects by
Statistical Analyses
The database was established using EpiData software (EpiData
Association, Odense, Denmark, http://www.epidata.dk/).
Reseach was carried out using Stata 12.0.
Ethical consideration
This study was approved by The Ethics Review Board. All
procedures and experiments performed in studies involving
human participants were in accordance with approved
guidelines and regulations, and written informed consent was
obtained from each participant.

RESULT

Table 1. General characteristics of the study object

General characteristics Statistical value (n=60, %)

Age, years

< 25 6.7%
25- 35 63.3%
≥ 35 30%
Education

Uneducated and Primary school 3.3%

Junior school 0%

High school 20%

College and above 76.7%

Gestational age at admission, weeks 31.1 ± 0.7
Parity

1 33.3%
2 23.3%
≥3 43.4%
Personal history
 146 Nutritional Status, Eating Habits and Foods Intake by Gestational Diabetes Patients in National Hospital…

Diabetes 0%

Glucose tolerance disorder 6.7%

Gestational diabetes in the previous 3.3%

pregnancy
Family history of diabetes 33.3%
Yes, %
Pre-pregnancy BMI

< 23, % 83.3%

≥ 23, % 16.7%
Plasma glucose (mmol/l)

Fasting 5.1±0.13
≥ 5.1 56.7%
1 hour (mmol/l) 10.9±0.33
≥ 10.0 73.3%
2 hour (mmol/l) 9.0±0.26
≥ 8.5 76.7%
HbA1C 5.4±0.08

Table 1 shows hat, approximately 63.3% of study participants
are between 25-35 years old with the majority of education
being college and above levels, accounting for 76.7%. The
average gestational age was about 31 weeks (31.1 ± 0.7) since
it was in the second and early trimester of pregnancy.
Number of pregnancies ≥ 3 times was 43.4%. History of
gestational diabetes in previous pregnancy was 3.3%, history
of glucose tolerance disorder was 6.7%. In this study, 33.3%
family history of having siblings having diabetes. The
nutritional status of patients with gestational diabetes pre-
pregnancy with BMI> 23 was 16.7%. After glucose tolerance
test, the ratio of fasting, after 1 hour of testing and after 2
hours were 56.7%, 73.3% and 76.7% respectively. The HbA1C
result in these patients was 5.4 approximately.

Table 2: Nutritional status and gain weight according to the nutritional status pre-pregnancy of study participants
Nutritional status Statistical value Weight gain at Recommendations to gain
pre-pregnancy (n=60,%) pregnancy weight according to IOM
BMI, kg/m² (kg/week) 2009 (kg/week) [31]
Malnutrition 16.6% 0.46±0.8 0.45-0.59
BMI < 18.5

Normal 76.7% 0.66± 0.05 0.36-0.45

18.5 ≤ BMI ≤ 24.9
Overweight 6.7% 0.93±0.29 0.23-0.32
25.0 ≤ BMI ≤ 29.9

Obesity 0% 0 0
BMI > 3.0

Nutritional status of study subjects was shown in table 2. The
history of pre-pregnancy weight of gestational diabetes
indicated the result. In particular, the majority (76.7%) of
patients with gestational diabetes had normal nutritional
status, 16.6% study subjects had impaired malnutrition and
6.7% with overweight. The patients who gestational diabetes
normal status gained weight of 0.66±0.05kg/week and
0.93±0.29kg/week in overweight pre-pregnancy, higher than
patients with gestational diabetes who were pre-pregnancy
malnutrition (0.46±0.8kg/week) and recommendations to
gain weight according to IOM 2009.
Nguyen Trong Hung et al. 147

Table 3: Eating habits of study participants

Percentage (%)
Frequency of meal consumption

Three times a day 100

Frequency of snack consumption

≥3 76.7
2 20.0
1 3.3
End of time of last meal

< 19h 0
19h -21h 56.7
>21h 46.3
Hobby of eating sugary foods 63.3

Table 3 showed the regularity of the meal and snack snacks a day. The last meal usually ended late between 19:00
consumption of the subjects. Investigation on nutritional and 21:00 (56.7%) and after 21 hours (46.3%). The majority of
habits indicated that 100% of study participants consumed 3 patients with gestational diabetes (63.3%) like to eat sugary
meals a day, more than 95% of all subjects consumed 2 or 3 foods (cakes, candies, soft drinks ...).

Table 4: Nutrient intakes status of the subjects

Nutrients Value
Energy, kcal 1841.7±92.2
Energy level, kcal/kg body weight 29.5± 1.5
Carbohydrate, g 243.4± 16.5
% total energy
52.3 ± 2.0
Protein, g 84.3± 3.9
% total energy
18.7±0.67
Lipid, g 59.1± 4.2
% total energy
29.0±1.6
Saturated fattty acide –SFA, g 15.7± 1.2
% total energy
7.7±0.4
Monounsaturated fatty acide –MUFA, g 17.7±1.6
% total energy
8.5±0.6
Cholesterol, mg 299.2± 41.6
% total energy
0.15±0.02
Iron, mg 14.5 ± 0.9
Folic acid, µg 403.5 ± 54.4
Calcium, mg 707.2 ± 44.4
Vitamin D, IU 21.3 ± 5.8
Vitamin B12, µg 2.3 ±0 .19
Zinc, mg 13.5 ± 0.75

Analysis of actual diets of study subjects was showed in Table 8.5% of the total dietary energy. The cholesterol intake
4. Total dietary energy was 1841.7±92.2kcal and energy level 299.2± 41.6mg/day.
of 29.5±1.5kcal/kg body weight. The carbohydrate intake
Analysis of the ration of some vitamins and minerals showed
(243.4±16.5g/day) constituted 52.3±2.0% of total dietary
that the iron in the diet of gestational diabetes was
energy. The protein intake of the respondents was
14.5±0.9mg/day. Amount intake of folate, calcium, vitamin
84.3±3.9g/day (equivalent to 18.7±0.67% total dietary
D, vitamin B12 and zinc were 403.5µg/day, 707mg/day,
energy). Amount of lipid intake was 59.1±4.2g/day,
21.3IU/day, 2.3µg/day and 13.5mg/day respectively.
constituted 29.0±1.6% of the total dietary energy. In which,
the SFA fat constituted 7.5% and the MUFA fat constituted
 148 Nutritional Status, Eating Habits and Foods Intake by Gestational Diabetes Patients in National Hospital…

Table 5: Foods frequency of consumption of the subjects

Number of times consumed
Food Item Daily 3-5 per 1-2 per 1-2 per Sometime No
week week month
Carbohydrate group

Rice 100% - - - - -

Potato, sweet potato 6.7% 16.7% 46.7% 30% - -

Noodles - 23.3% 43.3% 33.3% - -
Bread, dumplings 10% 33.3% 46.7% 10% - -
Cakes, ice-cream, … 23.3% 20% 46.7% 10% - -
Protein group

Meats 100% - - - - -
Seafoods 10% 43.3% 43.3% 3.3% - -

Beans - 30% 70.0% - - -

Eggs 10% 46.7% 40% 3.3% - -
Lipid group

Vegetable oils 86.7% 10% 3.3% - - -

Animal fat 3.3% 3.3% 13,3% - 80% -

Peannut/ Sesame 6.7% 3.3% 60% 30% - -

Nuts 6.7% - - - 93.3% -

Vitamin and Mineral group

Green vegetables 96.7% 3.3% - - - -

Ripe fruits 96.7% 3.3% - - - -

Milk and Drink group

Milks 86.7% 6.7% 6.7% - - -

Diabetic milk 10% - - - 90.0% -
Soft drinks 3.3% 3.3% 90% 3.3% - -
Beer, wine - - - - 3.3% 93.3%

As for high carbohydrate foods, the frequency of rice
consumption was daily, all kinds of potatoes, noodles, cakes
consumed with a frequency of once or twice per week were
46.7%. Among those, for high protein foods, the daily
consumption of meats (of poultry and livestock) was 100%,
seafood and aquatic products about 3 to 5 times a week,
43.3%, and legumes once or twice per week was 70%, eggs
with frequency of 3-5 times per week was 46.7%. With high
lipid foods, the daily oil consumption frequency was 86.7%,
the use of animal fats was seldom 80%, and the seldom use of
fatty nuts (walnuts, cashews ...) was 93.3%. To turn to, foods
rich in vitamins and minerals, the daily consumption of ripe
green vegetables and fruits was 96.7%. Some types of drinking
water are seen. 86.7% of pregnant diabetic women drink milk
every day, drink soft drinks once or twice per week is 90% and
consume beer/alcohol seldom 3.3%.
DISCUSSION
Currently there are many studies and standards on gestational
diabetes. However, in order to update and properly assess
the status of gestational diabetes in Vietnam, like recent
epidemiological studies, we apply the criteria for evaluating
gestational diabetes according to the American Diabetes
Association ADA 2017 [32].
According to many studies as well as published by the
American College of Obstetricians and Gynecologists,
pregnant mothers under the age of 25 years are considered to
be less at risk of gestational diabetes. The higher the age,
the greater the risk. Pregnant women between the ages of 25
and 35 are considered to be moderate risk factors and 35 and
older are considered high risk factors [33]. This study has
shown that about 63.3% of women with gestational diabetes
between the ages of 25 and 35 and about 30% of pregnant
women with gestational diabetes are over 35 years old. The
study of Jane E. Hirst et al. showed that the average age of
pregnant women with gestational diabetes was 31.21 ± 4.16
higher than the non-gestational group. 27.85 ± 4.73 [34].
Research by Ostlund also shows that mother age ≥ 25 risk of
gestational diabetes increased 3.37 times compared to the
group <25 years old [35]. Regarding the educational level of
patients with gestational diabetes, the study showed that the
majority of pregnant women with
secondary/college/university education accounted for 76.7%.
The results of the study are similar to those of La Thi Thanh
Tam et al. [36] and the study of Nguyen Khoa Dieu Van et al
[3].
The average gestational age of patients with gestational
diabetes is about 31 weeks (31.1 ± 0.7) from the 2nd and
Nguyen Trong Hung et al.
early 3rd trimester. According to the American Diabetes
Association ADA (2011) and the American College of
Obstetricians and Gynecologists (2010) recommends screening
for gestational diabetes for women from 24-28 weeks
gestation. The number of pregnancies ≥ 3 times was 43.7%.
History of gestational diabetes in previous pregnancies was
3.3%, history of glucose tolerance was 6.7%. Family history of
parents of siblings with diabetes is 33.3%. Our research
results are consistent with the results of other authors [34],
[37]. Ostlund also showed that mothers with a history of
gestational diabetes increased the risk of gestational diabetes
by 5.59 times [35]. A study by Jane E. Hirst et al showed
that: the rate of pregnant women with a history of stillbirth
in gestational diabetes was 2.97%, in gestational diabetes was
3.8%, the difference is statistically significant [34].
Diagnosis of gestational diabetes when patients have one of
the serum glucose values: fasting blood glucose ≥5.1 mmol/l,
blood glucose after 1 hour of legal testing ≥ 10.0 mmol/l and
blood glucose after 2 hours of solution testing ≥ 8.5 mmol/l.
The results of the study indicate that the blood glucose test
after the fasting glucose test after 1 hour of legal testing and
after 2 hours solution test were 56.7%, 73.3% and 76.7%
respectively. The HbA1C index is a measure of the stability of
blood sugar in the last 3 months. According to the ADA 2017,
the HbA1C is recommended for women with diabetes in early
pregnancies with a goal of <6-6.5%. If the mother is at risk of
hypoglycemia, it is up to the individual patient to set the
target HbA1 <7%. In the 2nd and 3rd pregnancy should
optimize HbA1C <6% and should check the HBA1C index
monthly. According to the results of the above study, the
HbA1C in these patients is about 5.4 ± 0.08, meaning that the
target is at the optimal level.
Monitoring pregnant women Gestational diabetes not only
monitors blood glucose indicators, it was important to control
and monitor the weight of pregnant women. According to IOM
2009 recommendations for weight gain in women Diabetes,
the weight gain of pregnant women depends on weight before
pregnancy. A pregnant woman before malnutrition in the
state of malnutrition, the total weight need to increase from
12.5-18 kg with the rate of weight gain in the 2nd and 3rd
pregnancy at about 0.45-0.59kg/week. Pregnant women
before pregnancy in normal nutritional status, the total
weight needs to increase from 11.3 to15.8 kg with the rate of
weight gain in the 2nd and 3rd pregnancy was 0.36-
0.45kg/week. When pregnant, overweight and obese
nutrition, the total weight need to increase from 5-10 kg with
the rate of weight gain in the 2nd and 3rd pregnancy was
0.23-0.32 kg/week. However, our research results show that
the rate of weight gain in pregnant women with normal
nutritional status and overweight in 2nd and 3rd trimester is
much higher than the recommendations. Some previous
studies have shown that excessive weight gain during
pregnancy also causes the risk of diabetes for mothers and
babies [15], [16], [38].
In addition, epidemiological studies on the risk of gestational
149
diabetes also clearly indicate the nutritional status of pre-
pregnancy women is one of the risk factors that are easily
encountered in pregnant women with diabetes mellitus.
Obese people with insulin resistance are susceptible to
diabetes. Doherty and et al found that obesity pre-pregnancy
was a risk factor for gestational diabetes [39]. Ta Van Binh et
al. showed that the prevalence of gestational diabetes
between BMI <23 and BMI ≥23 difference was statistically
significant [40]. Torloni's study, compared the group with
normal BMI, the risk of gestational diabetes decreased in the
low-weight group, overweight group, moderate obesity and
obesity increased OR = 1.97 (95% CI = 1.77-2.19), OR = 3.01
(95% CI = 2.34-3.87), OR = 5.55 (95% CI = 4.27-7.21)
respectively [38].
Analysis of nutritional habits, we noted in the study of
diabetic women divided into several meals a day: 3 meals and
2-3 snacks to distribute glucose consumption and reduce
glucose fluctuations serum after eating, better control serum
glucose [41], [42].
Conducting an analysis of the diet of pregnant women with
diabetes we recorded: The total dietary energy was about
1841.7±92.2kcal/day with an energy level of about
29.5±1.5kcal/kg body weight. The amount of glucose in the
daily diet was 243.4±16.5g/day, accounting for more than
50% of the total dietary energy (52.3±2.0%). The amount of
protein in the daily diet was 84.3±3.9g/day accounting for
more than 18% of the total dietary energy (18.7±0.67%) with
protein of 1.36±0.07g/kg body weight/day, 59.1±4.2g/day
accounting for about 30% of the total dietary energy
(29.0±1.6%). In particular, the amount of SFA fat accounts for
more than 7.5% of the total dietary energy, the amount of
MUFA fat accounts for more than 8.5% of the total dietary
energy and the amount of cholesterol was about 300mg/day.
The ratio of three thermogenesis substances in the diet of
pregnant women Gestational diabetes in our study was
Protein:Lipid:Carbohydrate = 18:30:52. However, according
to the recommendations of the American Abstinence
Association (2012) and the American Society of Obstetrics and
Gynecology (2017), the diet for pregnant women with
gestational diabetes needs to control specific carbohydrates:
The energy requirement was 30-35kcal/kg/day, of which, 20%
protein, 40-45% carbohydrate and 35-40% lipid. The amount
of saturated fat was less than 10% of the total fat. We noted
that the energy demand of pregnant women with gestational
diabetes of 30kcal/kg/day was also consistent with the
recommendations of the 2017 ADA but on the ratio of the
three triggers, but we found that some of the following
issues: First, the nutritional habits of Vietnamese people with
the highest lipid rate were approximately 30% lower than the
ADA 2017 recommendations for pregnant women with
diabetes. Secondly, according to the ADA's guidelines on
nutrition for diabetics and the guidelines for nutrition for
diabetics in Vietnam, the recommended carbohydrate rate of
50-55% was also suitable. Consistent with nutritional habits in
Vietnam. Thirdly, pregnant women often have a condition of
dyslipidemia, so the question was whether to follow the
 150 Nutritional Status, Eating Habits and Foods Intake by Gestational Diabetes Patients in National Hospital…
recommendations of the American Abstinence Association
(2012) and the American Society of Obstetricians and
Gynecologists (2017). For pregnant women with gestational
diabetes need to control specific carbohydrates: 20% protein,
40-45% carbohydrate and 35-40% lipid can increase
dyslipidemia. Fat quality was also an important nutritional
issue that was mentioned in the advice of pregnant women
with diabetes. Previous studies showed that one of the risk
factors for gestational diabetes was a high-fat diet [43], [44].
Fatty (high in saturated fatty acids, low in unsaturated fatty
acids), high in cholesterol [20]. Our study noted that SFA fat
accounts for more than 7.5% of total dietary energy, MUFA fat
accounts for more than 8.5% of total energy intake and high
cholesterol was about 300mg/day. This study found that
diabetic pregnant diets with saturated fat content of 8.5% of
total dietary energy in accordance with recommendations of
the American Abstinence Association (2012) and ADA (2017).
Analysis of diet of some vitamins and minerals illustrated that
the amount of iron in diet of patients with gestational
diabetes was 14.5 ± 0.9mg/day. The amount of folate was
400mcg/day, calcium in the diet was 700mg/day, vitamin D in
the diet was 20IU/day, vitamin B12 was 2.3mcg/day and zinc
was around 13.5mg/day. Compared to the recommended
level of some vitamins and minerals in pregnant women, we
found that dietary folate was 70% of the recommended
intake, Calcium was 60% of the recommended, zinc was
approximately 94% of the recommended. Vitamin D was 10%
of the recommended, Vitamin B12 was 7% of the
recommended.
However, the majority of gestational diabetes patients
(63.3%) prefer to eat sugary foods (cakes, candy, soft drinks
...). Our findings show a preference for sweets in pregnant
women with gestational diabetes was similar to that of other
studies [21]. However, there have been many studies proving
the relationship between high sugar and sweet drinks
consumption and the risk of gestational diabetes [23], [45].
Analyzing the frequency of food consumption, we recorded
the frequency of cakes consumption once or twice per week
was 46.7%. 86.7% of pregnant women with gestational
diabetes drink milk every day but are sugary and non-milk for
diabetics. Drinking soft drinks once or twice per week was
90% of pregnant women. 96.7% of pregnant women Diabetes
eat ripe fruits regularly. According to a study in the US,
conducting a comparison between women consuming 1 unit of
fresh water/month with women consuming 5 units of soft
drinks/or carbonated soft drinks/week showed the risk of
gestational diabetes was 22% (95%, CI: 1.01, 1.47) [46]. A
study in China found that ripe rations in pregnant women
with gestational diabetes were over 500g and higher in
pregnant women without gestational diabetes [20]. The
source of carbohydrates in the diet was very important, in
ripe fruits are high in glucose sucrose, fructose with high
glycemic index. Therefore, consuming a lot of ripe fruits with
a high glycemic index is also a risk factor for gestational
diabetes.
CONCLUSION
The nutritional diet of women with gestational diabetes with
the ratio of 3 thermogenic substances was not consistent with
the guidelines of the American Diabetes Association 2017 but
also quite consistent with the nutritional facts and habits in
Vietnam. The amount of cholesterol in the daily diet was
high. The recommended levels of dietary micronutrients such
as Calcium, Vitamin D, Zinc, B12, and Folate are about 60%,
10%, 94% and 70% respectively. Diabetic women have good
nutritional habits of sharing small meals, but choosing a
variety of sugary foods such as sugary milk, confectionery,
and ripe fruit leads to the risk of hyperglycemia. The status
of weight gain more than recommended in pregnant women
with nutritional status before pregnancy BMI>23 overweight,
obesity. The features of a history of gestational diabetes,
impaired glucose tolerance, history of gestational
enlargement, stillbirth, family history of siblings with
diabetes are consistent with epidemic studies in Vietnam and
internationally.
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